and impotent). A high number of the relatives of
those with chronic pain also suffer sadness and
anxiety and withdraw from social activities
themselves. 21
Effects on health care systems
Pain accounts for considerable expenditure and
consumption of resources in primary care. 27,28 In
a study by Breivik et al,1 60% of chronic pain
patients reported that they had visited their
clinician 2–9 times in the months before the study
commenced and that 11% had visited at least ten
times. A total of 70% visited their GP, whereas only
2% were treated by pain specialist.
People who leave their employment or lose their
job as a result of pain, and those who perceive their
pain affects their family, are those who use the
healthcare systems the most. 21 It has also been
shown that pain is often adequately diagnosed and
treated in primary care, resulting in excessive
appointments and overuse of healthcare resources. 21
Conclusions
Based on the definition of disease, most chronic pain
can be considered as a disease in its own right. The
new ICD-11 classification acknowledges that chronic
pain is a disease in its own right by introducing the
coding of ‘chronic primary pain’. Yet, at the same
time many patients with ‘secondary chronic pain’
have emotional distress and important interference
with daily activities and social participation.
As such, they fit into the concept of pain as a disease
while their pain can be a symptom of an underlying
disease.
Chronification should be considered as
a continuum where initially, pain could be
a symptom, but can develop into a disease. Therefore,
disease-specific treatment paradigms, focusing on
multimodal strategies, need to be applied, which
might differ from those were chronic pain is merely
a symptom of an underlying chronic condition.
Because of the high prevalence of chronic pain
and the resultant serious medical and non-medical
consequences, effective health care policies,
acknowledging pain as a public health priority, and
multidisciplinary treatment strategies to prevent
and manage pain and minimise the disability that
it causes, are required.
In a study comparing health-related quality of life
(HRQoL) in patients with acute pain and chronic
pain with those without pain, chronic pain patients
received the worst score in all dimensions of
HRQoL. 24
Effect on work
Studies have demonstrated that that absenteeism,
presenteeism and early retirement related to chronic
pain present a significant burden as least as great as
conditions that are typically prioritised as public
health concerns. 25 In the 45–65-year-old age group,
low back pain is one of the most frequently cited
medical reasons for loss of work. 26
Effect on social relationships and family
Chronic pain can restrict a person’s leisure activities
and social interactions. Family members often find
that they need to undertake care duties and must
become involved in decision making regarding
medical treatment and consequently suffer negative
feelings (including feeling overburdened, frustrated
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